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PERIANAL ABSCESS; A COMMON SURGICAL PROBLEM WITH SIGNIFICANT MORBIDITY
Haisar E. Dao*1, Jason Kempenich1, Juan Marcano1, Nishit Shah2, Kenneth R. Sirinek1
1Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX; 2Surgery, Brown University, Providence, RI
Introduction: Patients with a perianal abscess are a commonly encountered clinical problem by the practicing surgeon. Treatment is based on a prompt diagnosis and expeditious drainage of the abscess. Most patients can be treated on an ambulatory basis and require no further therapy. However, there is a subset of patients who will present with sepsis resulting in poor postoperative outcomes. This study, utilizing a large national database, identifies factors associated with the development of postoperative septic shock in those patients who are treated for perianal abscess.
Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP) database was queried for the year 2015. Patients with a principal diagnosis of perianal abscess were selected for analysis. Demographics, comorbidities, surgical procedure performed, length of hospital stay, readmission rates and 30-day postoperative mortality were analyzed. Categorical variables were analyzed using Chi-Square and continuous variables were compared using T-test. A logistic regression model was then created to assess the influence of independent variables in the development of postoperative sepsis. Significance was stablished with a P value <.05.
Results: A total of 1,777 patients underwent an operation for the treatment of a perianal abscess at NSQIP participating institutions during the study year. The mean age of these patients was 45.1 years (range 18-89 years), 68.8 % were male, 67.3% were white and 69.7% of the procedures were performed emergently. The mean total length of hospital stay was 2.6 days. Mortality rate was 0.3%, unplanned reoperation and readmission rate were 5.4% and 4.5%, respectively. A total of 34.4% of patients had sepsis on admission, while 7.9% developed sepsis postoperatively, and 1.2% of all patients developed septic shock. On univariate analysis, factors associated with the development of postoperative sepsis were: an abnormal WBC on admission (10.4% vs. 3.2%; P<.0001), emergency surgery (10.4% vs. 2.0%; P<.0001), steroid use (14.8% vs. 7.3%; P<.0001), and surgical procedure performed more than 24 hours after admission (14.0% vs. 7.3%, P<.003). Multivariable logistic regression demonstrated that the need for emergency operation, steroid use and an abnormal WBC on admission were associated with the development of postoperative sepsis (Table).
Conclusions: The development of life threatening complications with a perianal abscess is quite rare. Those patients on chronic steroid use and with an abnormal WBC on admission are at a significantly higher risk for developing postoperative sepsis. The presence of these variables should trigger a more expeditious surgical drainage of the perianal abscess.
Multivariable Analysis of Factors Associated with the Development of Postoperative Sepsis in Patients Undergoing Treatment for Perianal Abscess.
| N=1,777 | Odds ratio | 95% Confidence interval | P value | | Diabetes | 1.0 | 0.6-1.6 | NS | | Abnormal WBC | 3.6 | 2.2-6.0 | <.0001* | | Emergency operation | 5.0 | 2.7-9.5 | <.0001* | | Admission to operation greater than 24 hours | 0.6 | 0.4-1.2 | NS | | Chronic obstructive pulmonary disease | 1.1 | 0.3-3.0 | NS | | Congestive heart failure | 0.6 | 0.5-5.6 | NS | | Acute renal failure | 1.2 | 0.1-12.6 | NS | | Dialysis | 1.9 | 0.6-5.8 | NS | | Chronic steroid use | 2.4 | 1.4-4.1 | <.0001* | | Weight loss > 10% | 1.6 | 0.4-6.1 | NS | | Metastatic cancer | 0.9 | 0.3-2.7 | NS |
* Statistically significant; NS: not statistically significant.
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